Endometriosis and Crohn's Disease Side by Side: A Case Report

Abstract

Endometriosis is the presence of ectopic endometrial tissue at extrauterine sites. Symptoms vary greatly and depend on the extent of the disease, ranging from an asymptomatic state to a miscellaneous group of symptoms. The correct diagnosis of intestinal endometriosis is often delayed because it may clinically masquerade as a wide spectrum of diseases, mainly Crohn's disease. We describe the case of a 42-year-old woman who presented to our hospital with subacute bowel obstruction. She had been suffering from strong abdominal disorders for over ten years with recurrent abdominal pain and chronic diarrhea, sometimes with gross bleeding, resulting in impaired nutrition, weight loss, and several hospital admissions. She had been diagnosed with Crohn's Disease ten years earlier, which was established by imaging, endoscopic and histologic criteria. The gastrointestinal symptoms were recurrent despite the medication for inflammatory bowel disease (IBD). The patient underwent a laparotomy, which identified a large bowel wall thickening with severe mucosal edema and luminal stricture in the proximal ileum. An ileocecal resection and appendectomy with latero-lateral ileocolic anastomosis was performed. Histopathological examination reported a diagnosis of ileocecal endometriosis. After a three-year follow-up period, she has no gynecologic symptoms but still maintains chronic diarrhea and imaging and endoscopic criteria are suggestive of IBD. Intestinal endometriosis should be borne in mind when a woman of reproductive age presents with episodic gastrointestinal symptoms. Multidisciplinary care should be encouraged.